title: Motivators and hygiene factors among physicians responding to explicit incentives to improve the value of care.
abstract: BACKGROUND
  Physician's dissatisfaction is reported to be increasing, especially in primary care. The transition from fee-for-service to outcome-based reimbursements may make matters worse.
  
  
  OBJECTIVE
  To investigate influences of provider attitudes and practice settings on job satisfaction/dissatisfaction during transition to quality-based payment models, we assessed self-reported satisfaction/dissatisfaction with practice in a Rochester (New York)-area physician practice association in the process of implementing pay-for-performance.
  
  
  METHODS
  We linked cross-sectional data for 215 survey respondents on satisfaction ratings and behavioral attitudes with medical record data on their clinical behavior and practices, and census data on their catchment population. Factors associated with the odds of being satisfied or dissatisfied were determined via predictive multivariable logistic regression modeling.
  
  
  CONCLUSIONS
  Dissatisfied physicians were more likely to have larger-than-average patient panels, lower autonomy and/or control, and beliefs that quality incentives were hindering patient care. Satisfied physicians were more likely to have a higher sense of autonomy and control, smaller patient volumes, and a less complex patient mix. Efforts to maintain or improve satisfaction among physicians should focus on encouraging professional autonomy during transitions from volume-based to quality/outcomes-based payment systems. An optimum balance between accountability and autonomy/control might maximize both health care quality and job satisfaction.
authors.affiliation: Bassett Healthcare Network Research Institute, Cooperstown, New York (Dr Waddimba); Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, Massachusetts (Drs Burgess, Young, and Meterko); Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Burgess and Meterko); Center for Health Policy and Healthcare Research, D'Amore-McKim School of Business and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts (Dr Young); Focused Medical Analytics, Pittsford, New York (Dr Beckman); and Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Beckman).
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Waddimba
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Young
authors.forename: Howard B
authors.initials: HB
authors.lastname: Beckman
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006920:Hygiene; D007588:Job Satisfaction; D008297:Male; D008962:Models, Theoretical; D009042:Motivation; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017009:Professional Autonomy; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires; D016526:Workload